Provider Demographics
NPI:1356442107
Name:ROMANO, ROSARIO J (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:J
Last Name:ROMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 CASELLA WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6894
Mailing Address - Country:US
Mailing Address - Phone:631-834-0272
Mailing Address - Fax:
Practice Address - Street 1:75 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2119
Practice Address - Country:US
Practice Address - Phone:631-834-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00502007Medicaid
CP552OtherOXFORD
4603067004OtherCIGNA
AJ01123OtherMDNY
110042572OtherRAILROAD MEDICARE
2291019OtherAETNA
13659OtherVYTRA
NY3137011051Medicare PIN
4603067004OtherCIGNA
NY3137008991Medicare PIN